This article focuses mainly on spinal fractures due to trauma. For more in-depth information
about osteoporotic spinal fractures, please read Osteoporosis and Spinal FracturesOsteoporosis and Spinal Fractures (topic.cfm?topic=A00538).

Spinal fractures can vary widely in severity. While some fractures are very serious
injuries that require emergency treatment, other fractures can be the result of bones
weakened by osteoporosis.

Most spinal fractures occur in the thoracic (midback) and lumbar spine (lower back)
or at the connection of the two (thoracolumbar junction). Treatment depends on the
severity of the fracture and whether the patient has other associated injuries.

Understanding how your spine works will help you to understand spinal fractures. Learn
more about your spine: Spine BasicsSpine Basics (topic.cfm?topic=A00575)

Cause

Fractures of the thoracic and lumbar spine may result from high-energy trauma, such
as a:

Car or motorcycle crash

Fall from height

Sports accident

Violent act, such as a gunshot wound

Many times, these patients have additional serious injuries that require rapid treatment.
The spinal cord may also be injured, depending on the severity of the fracture.

Spinal fractures may also be caused by bone insufficiency. For example, people with
osteoporosis, tumors, or other underlying conditions that weaken the bone can fracture
a vertebra even during low-impact activities--such as reaching or twisting. These
fractures may develop unnoticed over a period of time, with no symptoms or discomfort
until a bone breaks.

There are different types of spinal fractures. Doctors classify fractures of the thoracic
and lumbar spine based upon the specific pattern of the fracture and whether there
is a spinal cord injury. Classifying the fracture pattern will help your doctor determine
the proper treatment.

The three major types of spine fracture patterns are:

Flexion

Extension

Rotation

Flexion Fracture Pattern

Compression fracture. While the front (anterior) of the vertebra breaks and loses height, the back (posterior)
part of it does not. This type of fracture is usually stable (the bones have not moved
out of place) and is rarely associated with neurologic problems. Compression fractures
commonly occur in patients with osteoporosis.

A compression fracture of the lumbar (lower) spine.

Axial burst fracture. In this type of fracture, the vertebra loses height on both the front and back sides.
It is often caused by landing on the feet after falling from a significant height.

Extension Fracture Pattern

Flexion/distraction (Chance) fracture. The vertebra is literally pulled apart (distraction). This type of fracture can occur
in a head-on car collision when the upper body is thrown forward while the pelvis
is stabilized by a lap seat belt.

Rotation Fracture Pattern

Transverse process fracture. This uncommon fracture results from rotation or extreme sideways (lateral) bending.
It does not usually affect stability.

Fracture-dislocation. This is an unstable injury involving bone and/or soft tissue in which a vertebra
moves off an adjacent vertebra (displacement). These injuries frequently cause serious
spinal cord compression.

Side view of a fracture-dislocation of a thoracic vertebra.

This MRI scan shows a fracture-dislocation in the thoracic spine. Note the disruption
of the spinal cord.

A fracture of the thoracic or lumbar spine causes moderate to severe back pain that
is worsened with movement.

If the spinal cord is involved, the patient may experience bowel/bladder dysfunction
along with numbness, tingling, or weakness in the limbs.

If the fracture is caused by high-energy trauma, the patient may also have a brain
injury and lose consciousness, or "black out." There may also be other injuries—called
distracting injuries—that cause pain that overwhelms the back pain. In these cases,
it has to be assumed that the patient has a fracture of the spine, especially after
a high-energy event such as a motor vehicle crash.

Emergency Stabilization

Patients with fractures of the thoracic and lumbar spine that have been caused by
trauma need emergency treatment. It may be difficult to assess the extent of their
injuries on first evaluation.

At the accident scene, EMS rescue workers will first check the patient's vital signs,
including consciousness, ability to breathe, and heart rate. After the vital signs
are stabilized, rescue workers will assess obvious bleeding and limb-deforming injuries.

Before moving the patient, the EMS team must immobilize the individual in a cervical
(neck) collar and backboard. The trauma team will perform a complete and thorough
evaluation in the hospital emergency room.

Physical Examination

The emergency room doctor will conduct a thorough evaluation, beginning with a head-to-toe
physical examination of the patient. This will include an inspection of the head,
chest, abdomen, pelvis, limbs, and spine.

Tests

Neurological tests. The doctor will also evaluate the patient's neurological status. This includes testing
his or her ability to move, feel, and sense the position of all the limbs. In addition,
the doctor will test the patient's reflexes to help determine whether there has been
an injury to the spinal cord or individual nerves.

Imaging tests. After the physical examination, a radiologic evaluation is required. Depending on
the extent of injuries, this may include x-rays, computed tomography (CT) scans, and
magnetic resonance imaging (MRI) scans of multiple areas, including the thoracic and
lumbar spine.

A CT scan taken from the side of a fracture-dislocation in the thoracic spine.

A CT scan taken from the side of a burst fracture in the lumbar spine.

Significant nerve injury due to parts of the vertebral body or disk pinching the spinal
cord

These fractures should be treated surgically with decompression of the spinal canal
and stabilization of the fracture. The procedure to decompress the spine is called
a laminectomy. In a laminectomy, the doctor removes the bony arch that forms the backside of the
spinal canal (lamina), along with any bone or other structures that are pressing on
the spinal cord. Laminectomy relieves pressure on the spinal cord by providing extra
space for it to drift backward.

To perform the laminectomy, your doctor will access your spine with an incision either
on your side or on your back. Both approaches allow for safe removal of the structures
compressing the spinal cord, while preventing further injury.

Extension Fracture Pattern

Treatment for extension injuries will depend on:

Where the spine fails

Whether the bones can be fit together again (reduction) using a brace or cast

Nonsurgical treatment. Extension fractures that occur only through the vertebral body can typically be treated
without surgery. These fractures should be observed closely while the patient wears
a brace or cast for 12 weeks.

Surgical treatment. Surgery is usually necessary if there is an injury to the posterior (back) ligaments
of the spine. In addition, if the fracture falls through the disks of the spine, surgery
should be performed to stabilize the fracture.

Rotation Fracture Pattern

Nonsurgical treatment. Transverse process fractures are predominantly treated with gradual increase in motion,
with or without bracing, based on comfort level.

Surgical treatment. Fracture-dislocations of the thoracic and lumbar spine are caused by very high-energy
trauma. They can be extremely unstable injuries that often result in serious spinal
cord or nerve damage. These injuries require stabilization through surgery. The ideal
timing of surgery can often be complicated. Surgery is sometimes delayed because
of other serious, life-threatening injuries.

Surgical Procedure

The ultimate goals of surgery are to:

Achieve adequate reduction (return the bones into their proper position)

Relieve pressure on the spinal cord and nerves

Allow for early movement

Depending on the fracture pattern, the doctor may perform the procedure through either
an anterior (front), lateral (side), or posterior (back) approach—or a combination
of all three.

There are many types of specialized instruments used in spine surgery. These include
metal screws, rods, and cages used to stabilize the spine.

An x-ray taken from the front shows metal screws and rods used to stabilize the spine
after a burst fracture.

Regardless of whether treatment is surgical or nonsurgical, there will be a period
of rehabilitation after a fracture has healed.

The goals of rehabilitation include:

Reducing pain

Restoring mobility

Returning the patient as closely as possible to his or her preinjury state

Your doctor may recommend both inpatient and outpatient physical therapy to help you
achieve these goals.

If your fracture was caused by osteoporosis, you are at an increased risk for additional
fractures. Your doctor will recommend treatments to address bone density loss during
your treatment and recovery.

In some cases, there may be issues that delay or complicate rehabilitation and recovery.
These issues include inadequate reduction of the fracture, neurologic injury (paralysis),
and progressive deformity of the spine.

AAOS does not endorse any treatments, procedures, products, or physicians referenced
herein. This information is provided as an educational service and is not intended
to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance
should consult his or her orthopaedic surgeon, or locate one in your area through
the AAOS "Find an Orthopaedist" program on this website.